The Clinical Impact of Dental Radiography

NEXT Equine DR

Dental radiology is the core diagnostic modality for veterinary dental care. Trying to diagnose and treat dental disease without radiographs is like trying to treat ear disease without an otoscope, or diabetes mellitus without blood glucose measurements.

If a practice is not currently taking dental radiographs, they are sending many, if not most, of their patients home with painful dental problems. Unfortunately, the pets seem to act fine, they eat well according to the owners, and rarely do they show any overt sign that they are in pain. Many owners assume that because there is no obvious pain, there is no pathology. Many veterinarians assume that unless a tooth is loose, it does not require treatment. Nothing could be further from the truth. The accompanying dental radiographs all illustrate cases where non- mobile teeth in apparently normal patients are associated with significant pathology. When these types of problems are found and addressed, the patients typically act “years younger”, according to the owners. If you start taking dental radiographs and treating the hidden disease in your patients, you will likely find that the majority of your positive client comments are generated from your dental cases. The following examples illustrate cases in which proper treatment would not occur without dental radiographs.

This radiograph of a discolored left upper first incisor shows an enlarged root canal system, indicating the tooth was dead and required treatment. No mobility was present.

This right upper fourth premolar had a small rough area along the palatal aspect of the gingival margin. The dental radiographs revealed destruction of most of the tooth under the gingiva. Although the crown seemed intact, the tooth required extraction.

This radiograph shows a large area of bone destruction (arrows) associated with a small cusp tip fracture (arrowhead). There was no exposure of the root canal system in this fracture. The exposed dentin in the fracture site allowed bacteria to migrate down the dentin tubules into the pulp chamber, resulting in an abscessed tooth. Despite the severe pathology, it might be years until this tooth was mobile.

Some digital imaging software allows for the easy importing of high-quality pictures, printing of client letters with radio- graphs and pictures, and displaying images from the pet on a large screen in the exam room. Owners love seeing pictures and radiographs from their pet!

The Dentalaire DTX digital dental system from Sound ® gives you the ability to “Wow” your clients, and educate them about their pet’s care. Additionally, the software is easily integrated with virtually all practice management systems, PACS servers and DICOM systems on the market.

Integrating Digital Dental Imaging into the Practice

The idea of dental radiology is a new one for many practitioners and their clients. Acceptance of dental radiographs, does not magically occur after obtaining the requisite equipment, but rather depends on the practice implementing a number of steps. These steps include deciding what the practice stance is toward dental radiology, educating the staff and doctors in the use and value of the equipment, obtaining educational materials that the staff can deliver to the clients, and coordinating the delivery of your marketing message to your clientele (see the previous articles for more detail). This process involves change, which is painful. You will have to invest a few hours of time and staff training to achieve good results, but the rewards in improved patient health, client satisfaction, and practice revenue will be enormous.

For those who still doubt that there clients will accept dental radiographs, I would point out the example of heartworm testing and prevention in my practice area. According to our own local heartworm survey results, our practice area has a minute incidence (less than 0.1%) of heartworm disease, yet most practices that choose to pursue heartworm prevention have achieved a high level of compliance. This is because heartworm testing and prevention was presented to clients as something that would benefit the pet. The disease was explained, the staff gave recommendations, and the doctors backed them up.

In other words, heartworm prevention was “marketed” to the clientele of the practice. I estimate that half of your patients require some form of dental care, and that most dogs and cats over the age of six years have at least one painful dental problem in their mouth. Most of these painful teeth have no mobility, and will only be diagnosed through dental radiography. It should be much easier to market a service that occurs in most of your patients versus a disease that rarely occurs.
It is just a matter of what you believe, and how you communicate this to your clients. I have worked with dozens of practices all over the country, helping them implement dental radiology. I have yet to find one practice, regardless.